Inspection citations
5’23
36’24
21’25
18’26
80 shown
| Date | Severity | What inspectors found | Visit |
|---|---|---|---|
| Aug 26, 2026 | E · potential | Provide and implement an infection prevention and control program. | Complaint |
| Aug 5, 2026 | E · potential | Provide and implement an infection prevention and control program. | Complaint |
| Jul 7, 2026 | D · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Complaint |
| Jul 7, 2026 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Jun 12, 2026 | E · potential | Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights. | Routine |
| Jun 12, 2026 | D · potential | Ensure that residents are fully informed and understand their health status, care and treatments. | Routine |
| Jun 12, 2026 | D · potential | Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function. | Routine |
| Jun 12, 2026 | D · potential | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Routine |
| Jun 12, 2026 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Routine |
| Jun 12, 2026 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Routine |
| Jun 12, 2026 | D · potential | Ensure each resident’s drug regimen must be free from unnecessary drugs. | Routine |
| Jun 12, 2026 | D · potential | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Routine |
| Jun 12, 2026 | E · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Jun 12, 2026 | D · potential | Designate a physician to serve as medical director responsible for implementation of resident care policies and coordination of medical care in the facility. | Routine |
| Jun 12, 2026 | D · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Routine |
| Jun 12, 2026 | E · potential | Provide and implement an infection prevention and control program. | Routine |
| Jun 4, 2026 | D · potential | Respond appropriately to all alleged violations. | Complaint |
| May 29, 2026 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Jul 1, 2025 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| May 22, 2025 | D · potential | Provide basic life support, including CPR, prior to the arrival of emergency medical personnel , subject to physician orders and the resident’s advance directives. | Complaint |
| May 22, 2025 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| May 22, 2025 | E · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Complaint |
| May 13, 2025 | G · harm | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Complaint |
| Feb 6, 2025 | D · potential | Reasonably accommodate the needs and preferences of each resident. | Routine |
| Feb 6, 2025 | E · potential | Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive. | Routine |
| Feb 6, 2025 | E · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Routine |
| Feb 6, 2025 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Routine |
| Feb 6, 2025 | D · potential | Provide enough food/fluids to maintain a resident's health. | Routine |
| Feb 6, 2025 | D · potential | Provide safe and appropriate respiratory care for a resident when needed. | Routine |
| Feb 6, 2025 | D · potential | Provide safe, appropriate pain management for a resident who requires such services. | Routine |
| Feb 6, 2025 | D · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Routine |
| Feb 6, 2025 | E · potential | Ensure each resident receives and the facility provides food prepared in a form designed to meet individual needs. | Routine |
| Feb 6, 2025 | E · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Feb 6, 2025 | D · potential | Dispose of garbage and refuse properly. | Routine |
| Feb 6, 2025 | D · potential | Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. | Routine |
| Feb 6, 2025 | E · potential | Provide and implement an infection prevention and control program. | Routine |
| Feb 6, 2025 | D · potential | Develop and implement policies and procedures for flu and pneumonia vaccinations. | Routine |
| Feb 6, 2025 | D · potential | Keep all essential equipment working safely. | Routine |
| Jan 21, 2025 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Oct 15, 2024 | G · harm | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Mar 15, 2024 | D · potential | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Complaint |
| Mar 15, 2024 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| Mar 15, 2024 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Feb 13, 2024 | D · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Complaint |
| Feb 13, 2024 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Jan 30, 2024 | D · potential | Reasonably accommodate the needs and preferences of each resident. | Routine |
| Jan 30, 2024 | D · potential | Immediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident. | Complaint |
| Jan 30, 2024 | D · potential | Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered. | Routine |
| Jan 30, 2024 | J · harm | Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody. | Routine |
| Jan 30, 2024 | E · potential | Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities. | Routine |
| Jan 30, 2024 | E · potential | Respond appropriately to all alleged violations. | Routine |
| Jan 30, 2024 | D · potential | Not transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged. | Routine |
| Jan 30, 2024 | D · potential | Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights. | Routine |
| Jan 30, 2024 | D · potential | PASARR screening for Mental disorders or Intellectual Disabilities | Routine |
| Jan 30, 2024 | D · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Routine |
| Jan 30, 2024 | E · potential | Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. | Routine |
| Jan 30, 2024 | E · potential | Ensure services provided by the nursing facility meet professional standards of quality. | Routine |
| Jan 30, 2024 | D · potential | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Routine |
| Jan 30, 2024 | D · potential | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Routine |
| Jan 30, 2024 | G · harm | Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. | Routine |
| Jan 30, 2024 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Routine |
| Jan 30, 2024 | D · potential | Provide safe and appropriate respiratory care for a resident when needed. | Routine |
| Jan 30, 2024 | E · potential | Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. | Complaint |
| Jan 30, 2024 | D · potential | Observe each nurse aide's job performance and give regular training. | Routine |
| Jan 30, 2024 | E · potential | Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist. | Complaint |
| Jan 30, 2024 | D · potential | Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited. | Complaint |
| Jan 30, 2024 | E · potential | Ensure medication error rates are not 5 percent or greater. | Routine |
| Jan 30, 2024 | E · potential | Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs. | Routine |
| Jan 30, 2024 | D · potential | Provide each resident with a nourishing, palatable, well-balanced diet that meets his or her daily nutritional and special dietary needs. | Routine |
| Jan 30, 2024 | E · potential | Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. | Routine |
| Jan 30, 2024 | E · potential | Provide and implement an infection prevention and control program. | Complaint |
| Jan 30, 2024 | D · potential | Implement a program that monitors antibiotic use. | Routine |
| Jan 30, 2024 | D · potential | Develop and implement policies and procedures for flu and pneumonia vaccinations. | Routine |
| Jan 30, 2024 | D · potential | Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status. | Routine |
| Jan 30, 2024 | D · potential | Keep all essential equipment working safely. | Routine |
| Dec 12, 2023 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
| Nov 10, 2023 | G · harm | Provide appropriate treatment and care according to orders, resident’s preferences and goals. | Complaint |
| Nov 10, 2023 | G · harm | Provide appropriate pressure ulcer care and prevent new ulcers from developing. | Complaint |
| Oct 3, 2023 | D · potential | Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. | Complaint |
| Oct 3, 2023 | D · potential | Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. | Complaint |
Medicare's severity letters: A–C minimal harm, D–F potential for more than minimal harm, G–L actual harm or immediate danger. Source: CMS health deficiencies file, processed October 1, 2026.
Questions to ask on a visit
Golden San Andreas Care Center
900 Mountain Ranch Road, San Andreas, CA 95249 · (209) 754-3823
Visit date: ____________ Spoke with: ______________________
Record on file
- Certification
- Medicare and Medi-Cal certified skilled nursing facility
- Medicare number (CCN)
- 056132
- Certified beds
- 99
- Legal owner
- San Andreas SNF Operations LLC
- Part of
- Golden Snf Operations
Full profile on Medicare's Care Compare. Source: CMS, processed October 1, 2026.
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